constructing and make sure we learn from the bad mistakes made in aurora. colonel norton, i want to talk about alexis for a second. served in the coast guard, correct? injured in 1999 is that correct? >> that's correct, senator. >> she was injured before 9/11 2001, there are no care benefits given to her? >> correct. >> if she was injured after 9/11 2001, what would her care of benefits be? >> she and her husband would be eligible for the special benefits and services in support, that includes training, respite care champ va a whole range of benefits that are eligible, available only to the post 9/11 era severely disabled veterans and full time care givers. >> mr. kovach you represent the paralyzed veterans, correct? >> that is correct. >> and i think paralysis was probably the signature injury of the vietnam conflict, is that not correct? >> that is true. that is true. >> all of which took place before 9/11, 2001? but the affliction is every bit as bad as anybody injuryed in 9/11? >> my wife speaks three langz languages and two college degrees and put her career on hold to care for me. and when i pass away, she has no benefits. everything goes away. she's never paid into social security, never paid into a 401(k), all my benefits go away when i pass, she's got nothing. there has to be a safety net for our cave givers. i'm thinking about the ones you're talking about, 65 and 75 years old that are caring for veterans from the vietnam war. they need a break. you can imagine a 65-year-old woman trying to get a man into the bed or transfer him into the shower or get him dressed that's hard work. they need support. >> both your testimony and that of colonel norton allow us to focus on that issue. i can promise you this don't know we can do it overnight, but that's something we need to focus on because it really is a telling line of demarcation that is leaving out a lot of american veterans and their caregivers and that's not right. we need to see what we can do to address that one way or another. mr. rowan in your testimony -- thank you for your testimony. do you think putting them under oath will get us the truth? [ inaudible ] >> if we put one of them in jail for violating the truth -- >> that would really help. i only go on this because -- in a past life i was an investigator for new york city council, they started doing that, it had a whole lot of different testimony coming out of people. especially when we did talk about sending somebody to jail. >> that -- the reason i mention that is we all dr. rowan and i, the members all know that accountability in the va is something we try to focus on. being accountable for the decisions they make. we also need to be people accountable for the information they let out that cast a light on the va that may or may not be exactly the best light or the correct light. and i think everybody needs to be held accountable, both those who are responsible to carry out duties as well as those dropping information in the media to cast the va on a bad light. they ought to be held accountable for the truth in that testimony. it is about time we got to the bottom of the barrel of the va find out where the root cause problems are and root them out because in my personal opinion 90% of the employees at va are great. they're doing a hard job, they're doing a good job, they want to help. veterans like their health care. but that 90% is being hurt by the 10% or less who are either in a five dom they want to protect or want to have mischievous activities. i think it is partly because overemployment and underproductivity, but your testimony was very helpful. i want to thank you for bringing that out. >> if i might add, senator, and i would suggest to you that the difference in the employees is the difference between those who are providing health care who are the ones that we meet where the rubber meets the road who are doing a hell of a job as compared to administrative types who get themselves into all kinds of trouble. >> as my pastor says in church amen. you're exactly correct. thank you, all, for your service to america and thank you for your testimony today. >> thank you mr. chairman. miss brown, you're not recognizedrecognize ed ed for five minutes. >> let me thank each one of you for your service. i was a little late today because i went to the women's memorial. we have that service and we have had it every year for 18 years. and colonel vor started the program and has done an excellent job. let me say i'm a little uncomfortable when i see all of you military people there and not one woman. women are the fastest growing group of service and as we move forward with our planning, and the schedulers, whoever makes these decisions, i would like to see that we have a female veteran service representative here with us. and i feel that i need to make that statement particular after i just left the women memorial. now, let me just say that we can blame the va for a lot of things, but it is our responsibility as members of congress as i stand here today on the 24th of this month, the denver project is scheduled to shut down. i am going on the 29th and it will be an interesting time because they will be shut down. and it is going to cost us $20 billion to shut it down and $20 million to shut it down and $2 million a month to protect it. to me it is a waste of taxpayers' dollars. now, the problem with denver didn't start overnight. and it didn't start with this administration. it had several additional administrations involved in it. and several different congresses. now, we need to step up to the plate and come up with the solution and not waste taxpayers' dollars and not disenfranchise those veterans from denver. i represent florida. i am happy to say that on this friday we're going to open up the veterans cemetery in florida, and on the 29th -- no the 26th we're going to open up the va hospital in orlando, florida, that i've been working on and we as a delegation, have been working on for over 25 years. right. we shouldn't take 25 years to do it. but it will open up. i want your comments about what's getting ready to happen in denver and the congress' lack of whatever, not being able to work together to get this problem solved it is unacceptable in my opinion. you want to say something about it, mr. chairman. >> can i say something? >> yes sir. i yield my time. >> i don't -- i wouldn't take the lovely lady's time. all the women must have been at that thing -- >> they were there. they were there. >> i want to tell you, three of these men said good things about women's health care. >> i appreciate it. >> they did a good job. on the -- just i want to put this point out, i appreciate everything representative brown said and ranking member brown said. and she's correct. but as we speak the reasons jeff miller is not here, he's at the houseworking on this denver situation. my last phone call last night at 11:00 was with secretary mcdonald work on the situation. we don't want the money to go to waste. we don't want it to be repeated again in the future. we also -- we talked about accountability, mr. rowan. it is time, if we're going to bury the hatchet, we bury it in the truth and plan for the future and do it right. we're trying to make sure everybody at the va comes together with everybody at the congress with a right road forward on completing the denver hospital. nobody is going to waste the taxpayers' money at this point, but we got to make sure the wasting and taxpayers money that is taking place in the past stops and that's what we're trying to do. >> thank you. >> i appreciate you calling attention to that. >> thank you. and i take my time back. i do have a question. it is pertaining to the gi bill. and also the veterans court. i have gone to several of the veterans court programs and they're very successful. we have several in my area, but they're not available to veterans all over the country. what are some of your recommendations? >> i'll address that, ma'am. first off, we prioritize women veterans. 20% of our membership is female. 30% of our leadership, which is an indication of the potential that women represent for this community, and we're looking forward to working with you on making that a priority for this committee, but for this entire country. america needs to understand that they are in combat, being wounded and serving on the front line. >> fastest growing group. >> yes, ma'am. yes, ma'am. when it comes to denver you know just briefly, we hope you all can get in the room without us and without the cameras and work this stuff out. >> i thought we had done that. >> apparently not. so -- >> absolutely. i thought it happened -- >> we will continue to do so. but the partisan squabbling and the grand standing and all that has got to stop. our veterans need results. >> i'm with you. i'm on that page. what happens when failure is not an option? we get it done. >> we haven't been getting it done as a group ma'am. that's part of what our testimony revealed. we hope we can work together on that and move forward. >> i don't know about this we. i'm not french. i do my part. >> yes, ma'am. well -- we're focused on the gi bill as well. our recommendations are in our testimony. we look forward to working with you. but we hope this is the beginning and not the end. >> yes sir. i want to talk about the blind. because that is very important to me. my sister-in-law is blind and they do have equipment, but you're saying the va don't have that equipment for the use of the veterans? i think we met and talked about that. >> yes, ma'am. we did meet in the hallway actually. the equipment is there. it is at the blind rehab centers. the problem is is getting the veteran to the blind rehab centers. if they're not service connected, the va will not pay for their travel to get there. and blindness does not discriminate between service connected and nonservice connected. >> so you're saying the secretary doesn't have the authority to do it. it is the legislative issue? >> the way the law is written title 38, section 111 says the secretary will grant travel to the service-connected veteran. that's what we want in s-171 and hr-288. we wouldn'tant that word in part g service connected removed and catastrophically disabled blind and paralyzed and be added. >> we would work on that. i want you to know, i visited one of those centers, they're doing an excellent job. in addition to that, i visited some of the prison systems that actually train the dogs that work with them. so there are a lot of good supportive partnerships that is going on. and thank you, all, again for your service. i yield back the balance of my time. >> i thank the gentle lady for yielding. now mr. kofman, you're recognized for five minutes. >> thank you mr. chairman. first of all, are there any folks from colorado please raise your hand? >> working on the hospital. >> work on the hospital. thank god for that. i want to thank ranking member brown, chairman isakson, chairman miller ranking member blumenthal for their help in their leadership in trying to get this hospital done which is in my district. but i think unfortunately it seems to be emerging as more of a parochial issue as if somehow this is a rocky mountain region or colorado issue. and it is really not. because the men and women that we utilize this hospital didn't serve the state of colorado didn't serve the rocky mountain region they serve this nation. and they serve this station in uniform and made tremendous sacrifices in behalf of all of our freedom. so this needs to be recognized as a national issue and not local thing. and so i think that's very important going forward. let me ask you all this question, and that is, first of all, mr. kovach, we have an incredible spinal injury center in the state of colorado called craig hospital. what is your view about allowing veterans to have access to that facility? should they choose so for the treatment? >> pva certainly supports choice, but we believe that choice should be the va hospital. i have plenty of friends at rehab. i know what they have got and it is not as good as the va. i can tell you that firsthand. it's not. >> whose decision should it be? the patient's decision or the va's decision? >> i think it is up to the patient to make that decision. you ask a patient whether or not they want it go to craig or the va, they're going to want to go to the va. >> really? okay. one issue that i'm concerned about is the transition from active duty military into civilian life. and so i was on the side as nco and on the officer's side. but illicit army nco officer marine corps and the -- i had an easy time going from illicit army to civilian life because i actually went to college under the gi bill. it was much tougher as a junior officer leaving the united states marine corps and going in civilian life. i wanted to be in business management, but didn't have a business degree, and had been in army, marine corps infantry and was so frustrated at one time instead of putting on my resume that i had been an infantry officer in the marine corps specializing in amphibious warfare, i put down i was involved in international real estate specializing in the acquisition of beachfront property. that didn't work. so i ended up having to start my own business. but i can do that because i was a young person an officer, i had more savings than had i been an enlisted person. what do you all envision in terms of being able to broaden opportunities under the gi bill in terms of ojt, apprenticeship type training to be able to make it mark work related than going to school? would anybody like to comment on that? >> i might take a shot at it. >> go ahead. >> john? >> go ahead. >> let me say one quick thing, the gi bill is an education program this time. you need to go back to what your colleagues did in 1944. the gi bill encompassed the whole series of things, not the least of which was getting people ability to start a business. you couldn't have a business almost if it didn't say veteran tailor veteran construction, veteran something, often funded by small business loans going through the gi bill. and those need to be resurrected as well. thank god they brought back the education part of that gi bill, but they need to look at some of the other aspects of it as well. >> colonel norton. >> thank you, mr. coffman. couple of things one, there is a proposal in the hopper i think as you know that would require all people coming out of military service to go through the gi bill education track as part of their tap program. we think that's really important that they have that initial exposure to the importance of education and training opportunities that the gi bill affords. another aspect of this issue, i believe, is that dod is gradually moving forward with getting service members, civilian credentials and licensing in fields that they're getting trained on, on active duty. that's extremely important so that they will have more options when they come out the door. if you're an avianics repairman you should be able to get the civilian license before you leave so you have that option moving forward. there is a number of other things we recommended in our statement. thank you. >> sir if i may. may a dress thati address that, sir? >> our members are using the gi bill at an incredible rate. i think what we have seen is that the employment environment, the education environment is pretty dynamic and rapidly change and the gi bill isn't necessarily keeping up. three recommendations that we made specifically is allow post 9/11 bill to -- allow veterans to use remaining entitlement to repay student loans. loans are a huge challenge for our community. but continually we hear the veterans want to cash in their benefits to use it as seed money to start a small business. they ask us over and over again is there flexibility to allow us to start a small business to start a new career, they're incredibly entrepreneurial and we would love to work with your team on expanding and exploring that. because there is a desire to grow and create small businesses at a very high level. and also very issues that -- want to highlight is allowing medically dischargeded very ran ed verydischarged veterans to use -- there are a number of upgratdup upgrades we can make to the gi bill. it has to continue to be a work in progress. >> thank you. i yield back. >> i thank the gentleman for yielding. senator blumenthal, you're recognized for five minutes. >> thank you very much, mr. chairman. again, my thanks to each of you for being here. i apologize i was temporarily away because i had to attend a legislative markup at another committee. and i want to just pick up on your point mr. rieckhoff i think that college affordability, college loan issue is one of the paramount issues of our time, particularly as it relates to veterans and i hope that you and others on this panel and your leadership and your members will give us the benefit and your views on this issue so we can make education benefits both more flexible and more effective. and i say that as a dad who has two sons, one who servinged in afghanistan afghanistan and another serving in the military now as well as two other children not in the military. i want to focus for the moment on the issue of the disability claims backlog. you know, in the congress in the media there are issues du jor. this issue of disability claims backlogs, so far as i'm concerned, continues to be a major challenge. and i wonder if that is true in your experience as well and whether you could comment on whether the va is doing better. the numbers say there has been some progress in addressing the backlog, but still we have a long, long way to go. in fact, we're seeing a growing appellate work load at the board of veterans appeals and the regional offices which means that like the proverbial snake that swallows a mouse, we can see the backlog problem moving at a different place in the system. sir. >> yes, senator. good to see you. yeah, i talked about that and i would like to focus again the reason why the backlog is coming down is two fold. one, the hump that we had that was caused by both the returning veterans in the recent wars, as well as the number of vietnam veterans applying for compensation for diseases that have now been recognized just created this huge demand. that's curving downwards. the other thing was they took all of their resources and put it into initial claims. and i focussed on the decision review officer is the key point -- person on these regional offices. they have taken them out of their regular job to the detriment to the appeals process, because now they're not doing the certifications that are necessary to take a veterans appeal from the regional office to the board of veterans appeals and they're in limbo. oftentimes for many years now, short circuiting the whole situation. more importantly, with what is concerning to me through -- talk ing to our service reps in the field, is that it is like the va is considering us the enemy. many regional offices are people not allowed to talk to anybody. you have an issue on a claim that has come back you can't talk to anybody. you have to take it and deal with it. too bad. i was a service rep -- i retired in 2002 until i got this job in 2005, i worked for three years as a service rep in manhattan va regional office. if i had an issue on a claim that came back to me i could bring it to the raider, never mind the decision review officer, to go over it if i saw an obvious error. can't do that anymore. they go, don't talk to us. plus, they want to create super regional offices to take it even further away from the regional offices and further -- the case is further away from us who work in the field. all of the vsos in the regional areas. and so we don't get to see anybody and can't talk to anybody. it is like we're the enemy. instead of working with us, we're working inging against us. and i really think that what is going on now is criminal. this whole idea that a veterans claim doesn't go anywhere and is not counted as a bad mark on the regional office and is not counted in the board of veterans appeals queue and can sit there for years. we know once it gets to be va it will take three to five years to adjudicate. as i pointed out time and time again, and i'll point it out one more time we win 70% of the time. that means that veteran waited anywhere from 3 to 5 to 7 years because the regional office basically screwed up. and didn't do the right thing by them the first time. that's unconscionable. and i think this issue that is going on because of the leadership is just frankly criminal. that somebody could sit on a case -- on something that should take them ten minutes to fill out. and wait years and years to get it done. and frankly, i've been trying to get a letter out of my operation to go to the undersecretary on this whole issue. if we found situations in puerto rico that were just obscene, and if they don't resolve these somebody's head is going to roll. >> i thank you for that very eloquent comment mr. rieckhoff. >> yes it is still a problem. it is a big problem. we have to put this in context. yes, the va dropped the backlog. they drove the car into the ditch. it was predictable. it was preventable. they drove it in the ditch and want to be congratulated for partially pulling it out. we still see hundreds of thousands of folks facing an adversarial system and i think john appropriately addressed that. i would encourage everyone watching, listening in this chamber to go to the weight we carry.org. it is a data visualization website that we created that allowed veterans to show how long they have been waiting. you can go by state, you can go by region you can see individual stories and see how long they have been waited so we can look ahead and hopefully help predict the next phoenix and prevent the next phoenix, but also the key issue i encourage this committee to address is we all know they're working on t what do veterans do in the meantime? that is the problem that continues to plague our community. you have financial stress, you have emotional stress where do you go for help in the meantime, while va sorts this out? they come to us. and we are overwhelmed with demand and other nonprofits and msos and btssos feel the same way. >> thank you. i have one more thanks to mr. kovach. and to others who have mentioned the issue of expanding access and choice to make veterans eligible when a local va facility cannot provide the service that is needed. when we measure service, it ought to be for the medical care that the veteran needs not simply whether there is a facility there to provide it. i'm assuming that other members of this panel are in agreement as well with that view. thank you all. >> thank you, senator blumenthal. i now recognize dr. abraham for five minutes. >> well, i, like dr. rowan, am honored to have a foster student with me today from bossier city louisiana. and is going to go into a curriculum and hopefully will do very well. mariah, will you stand up please? thank you very much. [ applause ] and certainly just a quick remembrance that everybody here in the room with memorial day coming up, they're surviving family members of our fallen heroes. we know they still continue to carry the water and the extreme burden. so just a heart felt thanks for that. representative o'rourke and i were in a meeting this morning with secretary mcdonald and undersecretary sloan and a whole kaud qadry of his people who helped him make these decisions that you and i have talked about today. and i think it was you, mr. rieckhoff that said you know they do i think also have their heard in the right place. we have to be in a position -- i'll use a poor term, but we'll have to lance the abscess, so to speak, before the healing starts. hopefully we're in the process now of exposing the bad things. these are things we all know and you guys know better than everybody else, you know the life, these things have been under the radar for years and years and just coming to surface. that's a good thing. we are getting them out in the open and hopefully we can fix it. mr. kovach back to you, we -- i was a co-sponsor of a bill that was just dropped the apprenticeship on the gi bill that will allow some funds to be used in a noncollegiate funding area. i think it is a great idea. and certainly it will help. the question i have and mr. rowan and mr. rieckhoff and anybody else on the panel the thing that senator blumenthal just alluded to on these backlog of disability claims, give me one or two specific things we need to do. i understand how bad it is. i'm on the -- i'm the chair of the subcommittee of disability assistance. we see those figures and we want to fix it. and we want to fix it efficiently and as quickly as we can. help us out here and, mr. rowan, i know you were saying as far as the officers that no long areaer address these claims, but give us specifics we can take back to our committees and start -- yes, sir. >> i would add one simple change that could be done right now on the board of veterans appeals is to allow the veterans appeals attorneys, when they make a ruling make it precedential. so when somebody decides something, it becomes law. so any other case that is similar to that should be adjudicated along those lines. i mean this is the only kind of legal structure where that does not occur. i mean, and so we can get bva attorneys sitting next to each other making totally different rulings on the same type of case. that's number one. the other thing is figuring out how to really redo that whole system. it just doesn't make sense. the other thing i think is get us back access at the regional offices. stop having our claims sent everywhere except where we are. i have a regional -- one of my people working in the buffalo regional office in new york. she services the -- a dozen counties in western new york. she can't talk to anybody now. it is like they have set up this wall between her and all of the people in the regional office on their claims. it is crazy. it would just resolve so many issues if we actually had a decision review officer who could make a decision. and we don't. >> colonel? >> thank you. just two things to add briefly. one is we believe that the new bill recently introduced by senators heller and casey had some practical low cost process improvement measures on the claims system so we commend that to your attention. the second item is that we have been and many of the groups at this table have been working with the dav on basically reengineering the appealed claims process to make it more efficient, to speed it up, basically allow the veteran the option of bypassing certain steps in order for the claim to move more quickly through the system on appeal. but retain with the veteran the option of going back into the legacy system. and there have been as you know at least one or more hearings on this. and we believe that the basic concept that put forward for a sped up appealed process is a good one. we commend it to your attention. >> thank you. out of time. thank you, gentlemen. i yield back. >> i thank the gentleman for yielding. mr. o'rourke, you're recognized. >> thank you. i will follow your lead and that of dr. abraham and acknowledge ernesto livatas. are you here today? in the back. thank you for joining us. [ applause ] great grateful he's spending a day with us here in congress and also wonderful that he gets to hear from each of you and he's been here throughout the entire testimony. so i think that can only be good. i wanted to reflect on some of what dr. abraham and i heard this morning with the secretary. one figure that just astounds me is that there are 50000 positions open within the va that they're seeking to hire for today. another intensive focus on wait times, wait times have improved approximately 0% across the country. and undersecretary gibson admitted today that while access has improved, more veterans are getting seen, wait times are actually going up because more veterans are being seen. there are more providers in the system, there is, even though that's problematic, there is more choice. so i think one of the difficult questions we need to address and i want to get your thoughts on this, is whether we should not difficult questions we need to egic address and i want to get your thoughts on this is whether we should not be a little bit more refer strategic on what we're hiring yo forur and what we're referring out. and, you know, mr. rieckhoff, i'm struck by your top priority, preventing suicides and caring for those who come back with the signature wounds of these most recent wars, post traumatic stress traumatic brain injury. tell me your thoughts on focusing that hiring that has to take place on the va primarily al hea on capacity to serve those tran sy significancinge ing transitioning service members the help we need to have and adeoff taking care of the iconditions . wounds disabilities, injuries sustained in combat or service and the trade-off is that you then refer out those things that are not uniquely service connected. and there is going to be a trade-off involved if we solve or this. we can pretend we're going it e love hire all 50,000 build hospitals in all communities, like the one i serve in el paso or acknowledge we have to set some priorities. would love toer w get your take on this. >> sir, we created the clay hunt bill after we lost clay. suici i left declay's funeral and was on my way to the plane and found was a out of another suicide on the way there. this is real. it is growing. and the clay hunt save act was alem is a good step forward. but no one should be thinking solved that this. problem is anywhere near close to solved. that's why we're keeping it our number one priority this year. i think framing it in a bigger sense sense, the thing that is. lacking a is a national call to action. it was great that we had a white house signing. most america saw that and said great, washington took care of this. andlth moved on. we got a critical shortage of mental health care workers and a badly damaged va brand that bob mcdonald is trying to fix.tivize folks don't want to work t at the va now. we have to incentivize them and dent s find ways theyho cannot just work a sui at the civa but serve veterans.d ever that's got to be a call to action that the president should make, to the entire country, and v. say, we have a suicide problem, a mental health crush, we need every american to step up., i you can step up and work at the va, the dod, work for a private re nonprofit, go back to school, and amazingly in all of these areas, i think the undervalued resource is us. in as b the post 9/11 veterans are standing by to help each other. >> sorry to interrupt you, i of really want to make sure i ask this in as blunt terms as possible. what if the nd cva was a center of excellence for pts, tbi, unique combat and service-connected world issues and there 100% chance that when you need to see that mental health provider, you're going to get in right away and it is going to be world class that ma care. and that thet be trade-off is there serv say pretty good chance that if s, are you have the flu, diabetes, or something that may not be uniquely connected to service or is comparable to what the general population sees, you'reic going to get referred out. maybe not 100% of the time, but more likely. what do you think about that?wait. >> this is the age old false choice put forward to veterans, t. we should figure out who goes toickh the front ofoff: the line. nobody should wait. lo that's the bottom line. if you have service -- >> i don't think that's going to fix it.ress >> i don't -- i don't think that a lot of these ideas are falli necessarily going tong work, that alifie we heard fromd congress in the e. last couple of years. but the bottom line is supply ispeople growing. and demand is flat or even probl falling. we don'tem have enought qualified people to deal with suicide. we don't have enough qualified people to deal with ptsd. we have to address the supply scand problem and address that alva at. can't do it alone. >> yeah. >> most of our members are torn. a lot of them will never go to priva the va especially after the va everyo scandal. we encourage them top do that. we got to recognize that as mor hospital networks, private onal h nonprofits, church groups . everyone else is picking up the slack. so we have got 'o look at this ling as more than a va problem, we have to look at it as a national health care priority. that's where we need to start. otherwise we'll be around the edges with only the people who are currently using va services. >> and i'll yield back, but i think we agree on almost ive an everything, it is incredibly urgent, it will require de the v everyone, not just the va but the communities in which we live and work, the provider population outside of the va but if something truly is going to be a priority and urgent it needs to be treated that way with limited resources. i think that we'll have to be some trade-offs. so, anyway how i appreciate mr your response. i yieldy back to dr. rowan. >> i'll take this opportunity to recognize my good -- >> can i just say one thing, i have to say this for the record.t' the majority of suicides, not the young folks coming home they're us.the olde enough of them unfortunately that is terrible and needs to ber year dealt with s.immediately, but unfortunately it is the older nds of veterans who are committing suicide in incredible rates, have been for years, still are, and many of them because they'reght ou retiring out andt getting into all kindswo of hot water. the other thing is this, the va needs to take people right out of school, which they won't do. i had a friend of mine, she wanted to go work for the va she got her masters degree she an tra was qualified, but they said oh, no you got to have a couplerely o of years work service. a job i would a rather take a kid out of school that i can train the way i want to train them than have re of to relyth on somebody who will ut of quit a job after working somewhere else for two or three years. so they need to do more of that right out of school getting people right out of school. the other thing is, and this is one of my people -- the va needs to document their recruitment kid efforts by specialty and report right to congress who they'reou hiring docto and who isr. going to look for them. >> we have just to emphasize i'm glad somebody took this kid right out of school and hired talki him as a doctor.about i much appreciated them doing that. and you're peo absolutely correct, miss brown and i were talking about this, one of the problems is not that people don't want to work for the va, it is just getting hired takes forever. and that's the problem. >> that's the problem. thank you. it is a misnomer to sit here and say people don't want to work for the va. they do want to work for the va. what happens is is it takes too long. the process. by the time they go through the they system, someone else has already hired them. so let's don't sit here and say that people do not want to go to the va, they do. and they want to work at the va. let's be clear. we have doctors and nurses and professionals, there are veterans that is coming out that want to work at the va, but our process is too long. i yield. >> i thank the gentle lady for yielding.se o i take this opportunity to e recognize my good friend senator boozman, dr. boozman, when he you v served in theer superior house, u very the house of representatives, was on the veterans affairs re and committee. and i yield to senator boozman. >> thank you very much. and i thank all of you all for being here and thank you so muchoff, for your advocacy. you all do a tremendous job in pushing things forward. i agree with you, mr. rieckhoffack. the danger is in the signing ceremony, you know.bout t everybody ishe patting themselves on the back. to ke the nation isep patting themselves on the back. much of congress. and you forget about thesewan, poin things. we do peo have to keep at the top of the list and mr. rowan, you made an excellent point that, you to know, the majority of people that are committing suicide are actually, you know, in their 50srvice co and things. so it is just something we have to go forward with. mr. minney, you mentioned the travel for nonservice-connected individuals with vision problems. you k what isno the major disease that they have that is affecting them? do you know what the primary he vietn nonservice-connected disease that is causing blindness? >> right now it is a tossup between macular degeneration and diabetic retinopathy. the vietnam community, how they're coming down with diabetes due to agent orange, so now that is creating -- nney: >> diabetes connected to agent orange and then the resulting vision impairment that's not service-connected? >> it is ama fight to get the second and third secondary disease associated.robl >> we need to fix that.having i that's an excellent point. one of the problems that we're having in arkansas, i know throughout thethe country there rans. has been a problem with va reimburseing local hospitals for the emergency medical care for veterans. when this the happens, the hospital or collection agency hired by the hospital may go after the veteran for the payment, if they don't receive it from the va. i guess my question to the panel is, is that something you're but a hearing about? i have a lot of concern about that because not only is it a problem now, you know again, is if with the veteran, but also with t now, th ue hospitals.that we if you don't pay them, they're not going to participate. the other problem is if we can't do it right now under this limited program that we have had in the past what is going to happen is the 40 mile rule, you know develops, and hopefully we'll see more and more people utilizing that as they get comfortable with that. if we can't do this program, then we're going to have huge problems with that program and, again, the danger is is that if you don't pay the providers, rticip theyat simply won't participate. and then you know, potentially coulden spill over into tricare and some of the other things that we work so hard to you know make sure that it is accessible to veterans. is anybody hearing any of those things out there?on tha not so much. good. >> senator i would just comment not so much hearing on that, but we are hearing a related that challenge and problem is that some veterans who are referred outside for care often that results in a prescription of some kind by the civilian provider and that becomes enormously challenging because then the veteran goes to the et, th local cvs or other retail drug provider, has to pay out of and be pocket, then they go back to the va, the va won't recognize the script, or they have to say you have to come to the va and be seen by us so we can write a is a script on our form larry.e act. so this is a huge issue that ect of wasn't o addressed in the choice act. that ne the whole prescription nator medication aspect of outside referred care is still an enormous gap that needs to be taken up and looked at. to >> i think you make a great addr point and pharmacy is something we have got to address. not only in that area, but also the problem with dod, you know them -- we talk about suicide things getting people stable, they c while they're still, you know in the service. all of a sudden, they come out, and then the pharmacy and the va, you know, those drugs not where being on the formulary and a lot changing people where you had a a lot lot of work and a lot of thing attention paid to tryth and get people in the right track. so that's something that we need as a group, as a congress, and ys. you all also. that's something really need to work on.e: ser soge thank you, all, very much, again for your service in so many different ways. we appreciate you. >> thank the gentleman for yielding.g he sergeant major walsh you're ways m recognized for five minutes.e >> to both the folks at the e else table and the folks behind than y we're always here on challenging issues but i leave always more is optimistic than i've ever been. there is no one else i want to be fighting these fights than t' you. i think back 'o that national character issue when president d that kennedy got asked about going to the moon and they say, we don't do it because it is easy, we do it because it is hard. i don't think he thought of that of the care at the va. but the fact of the matter is it is up to us to get it right. and t senator boozmanhe is right on the ag formularies. weaido harmonize the formulary and it is stripped out at the end. that's why you do 2.0 and 3.0 et the and keep at it. i know for you it must feel like groundhog groundhog's day. we're back here year after year. i get the feeling on this, it is have different now.pred it is different because of sitting crisis.ppened and, again anyone who throws up their hands and says who could ni havestra predicted that, some of youyone. sitting at this table know that before phoenix happened, you a sur were talking about it and we inju were talkingri with administration folks about it and got nowhere.t. so it is not a surprise to anyone. nor will it be a surprise on these injuries that crop ingy s thaties that are coming. this bubble is could ingming. look at the vets, their bubble is not coming until 2050. there will somebody congressmen sitting up here at that time ' saying, dang, we couldn't have able. predicted that this was going to happen. and yes, you could have. so make the changes now. they ne it is not a false choice.few te we hold people accountable. we make people accountable. we swear them in. if they're criminal, we send them where they need to go. but we can plan for the future it h and fix it.as so let's do both together.to do this is our chanceit to make a generational change. and it has to be there because here is the alternative no one else is going to do it. if it is not the folks here and the folks doing this there is going to be resistance. w it is the nature ofas bureaucracy, public and private, to resist change. here is the goodn. news. we can make changes.as we eve started to. me and paul was right. vi clay hunt was a step in the right direction. but as everyone else here said this is about mental health parity and the view of the public sector to view that too. that's where it is going to start. we can change behaviors.i wa we can change how people think about it. i want to come to a granular issue on this, though because i think we can't lose sight of this. there are things we canse s start fixing today and make differences in people's lives on' that and john, mr. rowan i ' wonder if yos u would tell me, can you explain really quickly what the relationship with oim and n 1991 the va. what do they do together and what is going on here? >> the institute of medicine wasnual brought into play in the 91 act of the agent orange act in 91 where basically the institute of medicine was asked on the biannual basis to report out on research that they would look atiden of agentti orange related research wou and anyld diseases that they felt were identified as a result of that, that would then eventuallythat end up on the presumptive list, which now is rather substantial for vietnam veterans. and that's been the thing. resea the problem with it, of course, is one of the reasons why we talk about doing research is in fact there is no research. the va has never done research in agent orange. so was oim was scratching around resear whereverch they could find stuff instead of having original research to review.king abo it was a shame. and oim, in the toxic research acts we're talking about, we're also talking about toxic wound act, which we're hoping to have as a second round after we get rans w the first one passed, which would basically extend the 91 act to include persian gulf and they more recent veterans where the institute of medicine would start studying them now. the one thing about the -- nice about the oim, they were .o.m. considered off to side. though it is interesting, we see the va just recently, put up barriers. when the oim basically told the va you guys really screwed up when it came to the c-123 crew members and pilots and crew, that they agreed those planes were toxic even despite the va basically disavowing all knowledge. >> this is the pont i want toil e this bring up. this is why i say this to my colleagues. this -- while it may be a be granular issue, it is a broader one because this is about o see research, this is about best depl practices and this is about cutting off problems before they become as big as they are. no we know we're going to see thesei bring things from berm pits to depleted uranium, they're h coming. the research needs to be done on t now. the treatment planr s need to be done now and we need to acknowledge this. i bring this up because i think s in p itar shows and, secretary assures resou us andrc i hope he continues to push on this, this insular nature of the va to not take outside experts on this and partnerships, it is a waste of resources, it is ended up vent t setting us up for another situation with agent orange claims that will come later for this generation. and this is what i'm talking about. we can prevent those things now if we choose to do so. so, thank you, keep pushing. >> if i might continue that theand ba other thing was, the dod very clearly had research that showed that these claims were claims were toxic u.in there but the va wouldn't acknowledge it. it basically hid it. there is just a mind set : we a somewhere in there that just people don't think these kinds of illnesses count. >> we're going to come back at it and we'llmboru wh try to push that soon.tor thank boyou chairman. >> thank you for yielding. >> thank you mr. chairman. it's great to be here and e see all of you who have served in so many ways. i appreciate that. and i know the issue of 1 the denver hospital has come up. i'm from southern colorado, and e fini although it'shs not in many ss fin districtan veterans do need that hospital to be finished. the existing facility is just . not up to par. so i know it's a mess financially. i don't know the financial solution, but we have to find a ion. way to bring all or part of the hospital to completion so it can be used. i'd like to ask this question. i also ask this it of secretary mcdonald when he was here earlier this year.g the and that is how can we find a better way to have ave a seamless moment transition for our active duty talked men and women leaving the department of defense, going intos the va. just moments ago we talked about matching form lairs. we that's probably one step in the and mo right direction. but what are some other ways you'd like to propose that we can work on for a better and more seamless transition? >> congressman, if i may? >> yes. >> the one issue i can see is at this time, the department of veterans affairs is only employed by 33% veterans. it was supposed to be veterans taking care of veterans. if you take the rans66% that aren't veterans, once the veteran transition, those folks don't way of understand the military health care system or even the military way of life. so i think one of themore bestwi ways to do it is to actually hire more veterans within the va health care system. that's one approach. >> thank you. >> you're welcome. >> fmmsir, we have five specific recommendations. provide oversight by monitoring the progress and development of the dod and va health records. remember that? we all stood up with the president five years ago and talked about the initiation of a a plan. that plan is still somewhere tion to ongoing.them automatically troops leaving active duty service with an option to opt out.lan get them in when they are still in and have that be more seamless.to atme fullynt implement the plan to develop an automated system to transfer the records from the va electronicallyllow and implement the exit physical and improve the transition of national guard service records to the va. those are five suggestions we have and happy tomore follow up with your staff in more details.t the >> we have had that it for the last five years. we had a ploon but we hadn't executed the plan. i don't think it will be until the ma you sit down with leadership from dod and say what's a malfunction. how are you going to implement it? until someone has oversight and positive direction, it's not going to happen. >> thank you. would anyone else like to grt help rofess answer? >> we would suggest more needs to be done in terms of theiofrom y recruitment of physicians, nurses and other medical professionals from dodgs when they complete their term of service or when they retire. things like fellowships post doctoral opportunities, research even recruitment lly stipends, if you will, to attract them into va service. but that gets back to the ranking member brown's point about the long delays in the va artmen process. if somebody isns certified as a physician in the department of seaml defense, it ought to be quick e easy and seamless to move them over into the va and provide to opportunities for them including reasonable incentives for them to want to affiliate as a va medical professional. >> once again, at this time there are between 40 and 50,000 he depar unemployed navy coremen and air affai force health technicians. the department of veterans affairs will not hire them based on their military dod education. an individual could be an x-ray n the tech in the army for ten years want to go to work for the va and the va won't hire you because you're not credentialed. there's part of the problem. dod needs to credential the enlisted medical personnel so they can be -- have the opportunity to go. to work for the va. so there's a disconnect right take ca there. if you canin take care of an individual while they are in they a uniform, why can't you take care of them when they are a veteran. >> thank you.ssue. >> i'm going to speak for my air dredger. his son is a major in the air force and a neurosurgeon.et out neurologist, excuse .me. but the bottom line is this. he's looking around to get out quite honestly, and bottom line t is head hunters arehe telling him to not think about the va because we're not looking. despite the secretary having ever d told my secretary he was going or you to go after his son, he never did. >> thank you again for your answers and for the service that you provide. thank you, mr. thchairman, i yield back back. >> again, i want to thank all yof you for being here and to thank your organizations for what you do for our veterans and their families. now i'll take this opportunity to yield to ranking b member brown for any closing comments.rvice co >> i just want to thank you all for your service, for your comments. clearly, we have a lot of work to do, but asinki we go into their memorial dayse thanking all of the veterans for their service and the women veterans, you know, the first president georgee washington said whether or not young people want to join the military will depend on how we i am c treat theom veterans. we and i am committed that we will continue to work to give them the service and the quality care that they need. i mentioned earlier about denver. on the 24th if we in congress have not come up with a plan to authorize additional so they can spend money, that project is going to close. that will cost $20 million. and it will cost $2 million a month that is a waste of taxpayers' dollars. we can blame va. i said we can blame the congress because we hadn't authorized in the 50 years. blame whoever you want to but the veterans should not get the service they need. but what happens when failure is is not an option? we have to get it done.to thank you. >> thank the gentle lady for yielding. i want to take this opportunity to thank all the people who are here, all their organizations and one of the things i think you're seeing with this committee, i've been here six and a half years. plz brown has been here 23 years. and one of the things that i have noticed in these hearings is i the attendance of the members. there's much more interest in year. the last year. it's doubled or tripled. and they are very meaningful. i have learned a lot of things . today and things that are going to be simple. bip things that are not going to be hard to fix. it is a bipartisan effort i think might weadd.sides. i think you're seeing input from both.l have t the veterans choice card is not being implemented as the congress intended it. we'll have to do oversight on that. but i canetna also tell you being a vietnam era veteran, i served in korea, i see a lot more emphasis in 19 toward helping veterans than when i got out of the army, i can tell you that. basically the gate didn't hit me on the back end goinghi a i out and that was about. that was the only connection i got. there was really no program, -9/11 there wasn'tg. anything. we're doing much better. the g.i. bill is a phenomenal benefit. our country is better off for it. we'll get the money back in spades. there's no question about that. we'll benefit mightily from that. on the veterans hospital in built denver, i mentioned this in a hearing they built a coliseum in to rome in eight years and it looks like we're going to exceed that. different labor issues i realize that and they didn't have the epa on them but it looks like you could build a hospital for less than $1,700 a square foot and i think about how much care that mr. kovak mentioned we could be doing. i didn't sign on to be the project manager for every va r an hospital bill.tee they can do better and they will do better. the oversight from our committee will do that. it's a privilege, as i said, to start my comments to serve on this committee, to serve those now who have served my us and i and i will justho -- i have been to afghanistan twice hope to go again. we have the most courageous volunteer and highly trained ession military in the history of this country. it's amazing the professionalism these young- people every time i speak, there are three things i will never ever apologize for soldie spending money on. one, if you're a soldier in the field, i want you to have whatever you need to protect you and your comrades, period, you c whatever you need. number two, when you come home, i want this country to s

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